Does My Child Need Feeding Therapy?

Almost every young child goes through picky phases. So how do you know when it is more than a phase? These are the signs that are worth taking seriously. This is a guide, not a diagnosis, and only an evaluation can tell you what is going on.

Signs related to growth and nutrition

• Weight gain or growth that is slower than expected, or that your pediatrician has raised
• Eating very few foods, or a list of foods that is shrinking
• Relying on a small number of foods or drinks for most of the day
• Needing supplements or a feeding tube to get enough nutrition

Signs related to safety

• Coughing, choking, or gagging during or after meals
• A wet or gurgly sounding voice after swallowing
• Frequent vomiting with meals
• Frequent chest congestion or breathing illnesses, which are worth raising with your pediatrician

If a child is choking, struggling to breathe, or turning blue, call 911 right away. Read more about swallowing difficulties.

Signs related to skills

• Difficulty chewing, or avoiding foods that need chewing
• Holding food in the mouth, spitting it out, or pocketing it
• Trouble moving from purees to textured foods, or from bottle or breast to cup and solids
• Meals that are very long or very tiring

Signs related to behavior and emotions

• Strong distress, gagging, or refusal when certain foods are present
• Meltdowns or tears at most meals
• Fear of eating, sometimes after a choking or vomiting episode
• Meals that have become a daily struggle for the whole family

What is usually normal

Many toddlers go through stretches of eating less, refusing foods they used to like, or being wary of new foods. Appetite varies from day to day. These patterns are common, especially between ages one and three, and often settle on their own.

What matters is the overall picture: Is your child growing? Is the range of foods holding steady? Are meals mostly manageable? When the answer to those is no, it is worth asking for help rather than waiting.

What to do next

1. Try the quick check. Our picky eating quick check is a short list of signs. It does not diagnose anything.
2. Talk to your pediatrician about growth and any medical causes, such as reflux or constipation.
3. Ask for a feeding evaluation if feeding concerns continue. You do not need a diagnosis or a referral to ask for one.

If you are not sure what feeding therapy involves, read what pediatric feeding therapy is. If you are wondering whether your child's eating might be something more than picky eating, see picky eating or ARFID.

Even one feeding concern is a good reason to reach out. Waiting to see rarely helps if something is making eating hard.

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